A blog about getting more done by working less

December 19, 2016 / askpang / Comments Off on Constant availability, job performance, and the loss of professional autonomy

In the Martin Scorcese movie Goodfellas, Henry Hill explains how people interact with the big Mafia boss, Paul Cicero.

He got all his calls second hand. Then you’d have to call the people back. There were guys, that’s all they did all day, was take care of Paulie’s calls.

For a guy who moved all day long, Paulie didn’t talk to 6 people.

This was a sign of how powerful Paulie was. You didn’t call him. You didn’t talk to him. You talked to someone, who talked to him, who’d then get back to you.

In a world as action-driven and performative as (the imaginative world of) the Mafia, being able to interact in such a limited way is a sign of real power.

Indeed, you can measure how powerful someone is by how accessible they are, and how easy it is to figure out how to talk to them. Me? You can find my contact information easily. Larry Ellison or Bill Gates? Good luck.

During the question and answer period after a talk I gave on preventing burnout, the male internist, a faculty member at a university medical center, told the audience that hospital administrators had recently begun requiring that physicians list their cell phone numbers with the contact information on the organization’s website. There were no guidelines included about when and under what circumstances patients should use the numbers.

He told us, “I now get texts from patients who expect an immediate response. I was recently in clinic seeing patients when a patient texted me twice in an hour, then when I didn’t reply called the office and yelled at our staff. This summer I was out of the country on vacation with my family and received multiple texts from patients. No matter the time of day or the seriousness of the medical condition, patients have complete access to contacting me. I feel like I’m never off.”

Put simply, this policy is bonkers. Heaven knows I like the idea of a doctor being accessible when I really need, but I also like dealing with a doctor who isn’t exhausted from having to answer texts at 1 a.m.

It’s not like burnout wasn’t already a problem before the rise of smartphones. Mayo Clinic physician Tait Shanafelt has been measuring the extent and impact of burnout on American doctors, and he conducted surveys in 2008 and 2010 measuring burnout rates. He found in his 2010 survey, for example, that 40 percent of surgeons reported feeling burned out, 30 percent were depressed, and those who felt burned out were more likely to have made a “major medical error” in the previous three months. Poorly thought-out policies like publishing a doctor’s cellphone number will only make this worse.

More broadly, this is another indicator of how the profession of medicine has lost status. When you lose control over your schedules, see your privacy eroded, and have to interact with other people under the assumption that you don’t get to set up and maintain boundaries between their working and private lives, you’ve lost status– and your work is likely to suffer, too.